Navigating Through the Emergency Room Experience

As a health care consumer seeking emergency room (ER) care for yourself or someone you are advocating for, you may consider an Urgent Care Center as a viable alternative to the ER if the ailment is not potentially life-threatening. Most of these centers are open 365 days per year from 8:00am to 8:00pm. The doctors who examine you will be either Family Practitioners or trained ER doctors. Basic laboratory work can be done and most centers have the capability to take Xrays. Wait time is considerably less and if the situation is determined to require the patient to be seen in the hospital ER, the center will make all the necessary arrangements for ambulance transport. Upon arrival at the hospital ER, the patient will be seen promptly by the hospital physician. Do NOT drive yourself or personally transport anyone with signs and symptoms of a potentially life threatening ailment to the ER. CALL 911. You do not want anyone to stop breathing, have a cardiac arrest, heart attack, seizure, or stroke in your car.

What to Bring:

If possible, be sure to bring with you your completed PatientAction.com online Health History, your health insurance ID card and the containers from any prescription and non-prescription drugs you take along with the dosage of each drug. This will insure the continuity of your current medication regime and will help save precious time in your treatment and care. Be prepared for those containers to be sent home if you are admitted to the hospital. There is too much inherent danger in the possibility of drug overdose or negative drug interactions when patients have easy access to their own personal drug supplies. If you have Advance Directives brings them with you. These documents indicate what care you desire in the event you are unable to make those decisions for yourself at any given time. If you don’t have any, tell the hosptial staff you’d like to sign them and see if they can accommodate your request.

If you think you might be admitted to the hospital as a result of this visit, you may want to pack a small bag with some personal/toiletry items in it. If you wear contact lenses, bring the supplies you need for their care. Better yet, leave them home and bring your eyeglasses with you. Be prepared to send ALL valuables home. You will not need any of your jewelry, money or credit cards while hospitalized. If have a difficult time sleeping without your own pillow, bring it with you in a brightly colored pillow case from home in case you are admitted. This way everyone will know that this is your pillow. This will be especially helpful for the car ride home if you have any type of surgery. You can hold the pillow firmly against your incision as a splint to help minimize any discomfort caused by hitting the bumps along the road on the way home. DO NOT bring the pillow into the ER. It may get lost. If you are admitted, be sure to label any personal items that you are keeping with you with your name written on a piece of tape. This will prevent any accidental losses of personal items such as canes, walkers, etc.

What NOT to Bring:

Leave all valuables at home. Don’t pack cash or jewelry. Leave your wallet, credit cards, and check book home. You will not need them and there is always a chance that they could disappear.

Patient Confidentiality:

When you arrive at the ER you will be asked many questions. Many of these questions will be very personal and highly confidential. Feel assured knowing that all of your information will be held in the utmost confidence. More than likley the staff person that will be collecting your information will have undergone a background check prior to being hired. In addition, HIPAA, the Health Information Portability & Accountability Act of 1996, further protects your personal information by holding EVERYONE in the health care arena legally responsible for maintaining your confidentiality. (HIPAA: http://www.hhs.gov > Click on the link “Regulations”).

Anxiety in the ER:

When you or someone you’re advocating for is experiencing signs & symptoms that necessitate being seen in the hospital ER, this can be an extremely anxiety-provoking experience. You don’t feel well. You are scared of the process and the outcome. You may be afraid of dying. You may be alone. You may be concerned about having to be hospitalized. You may be concerned about being away from your home, family, job or pets. The environment is not always user-friendly. There are lots of other health care consumers seeking the same care that you are. They don’t feel well either. They may be experiencing the same anxieties and concerns that you are, and/or they may be experiencing a life threatening crisis, as well. They may not speak the same language or share the same culture, health care traditions, hygiene practices, or coping skills that you do.

What to Expect Upon Arrival:

Depending on when you arrive at the ER it can be quiet and peaceful or it can be noisy and chaotic…especially on the weekends or if you come in via an ambulance with a life threatening condition. Emergency Rooms are traditionally hectic and stressful for all involved including yourself, your family and friends and also the staff. The calmer you are, the more accurate and complete the information will be and the better care you will get. If you have your PatientAction.com online Health History with you this will save precious time , especially during life or death situations, giving the ER staff all of the vital information they need to help make an accurate diagnosis. The person accompanying you to the ER may end up being with you for hours. They should bring reading materials, drinks and snacks, telephone and charger, and a sweater/jacket with them.

How Long Does it Take to Be Evaluated?

How sick you are will determine how quickly you get seen by a physician. When you arrive at the ER, you or your advocate will be asked for your Health History and your health insurance ID card. Be prepared to explain your symptoms and give information about time of onset. If you are in labor or experiencing a life threatening condition, the ER of a private hospital will have to see you even if you don’t have health insurance. For any other conditions, the private hospital can refuse care and refer you to the ER of a local hospital that accepts patients without health insurance.

Who Determines When You Will Be Evaluated?

You can expect to be evaluated by a Triage Nurse upon your arrival to the ER. That Registered Nurse (RN) will talk to you or the person accompanying you (your Patient Advocate) and will determine the order in which you will be seen by a doctor. Facilities will usually care for the most critically ill or injured patients first and that may mean that you may have to wait hours to be seen, especially if the ER is busy with life-threatening scenarios (such as chest pain, heart attacks, asthma attacks, gun shot wounds, stab wounds, traumatic injuries, poisonings, motor vehicle accidents, etc.) You will have to just sit and be patient. Do not eat or drink anything without first asking the nurse in charge. If you have to urinate, also ask if they might be needing a urine specimen from you before you go to the bathroom. Don’t expect to be medicated for any pain you are experiencing when you first arrive. A diagnosis must first be made before they administer any medications which may mask your symptoms and interfere with making a diagnosis. If your symptoms change while you are waiting to be seen, be sure to let the Triage Nurse know.

You and Your Patient Advocate:

If you desire for the person accompanying you to the ER to be able to advocate for you, you will need to let the hospital know that in advance of your treatment in order to protect your patient confidentiality & privacy. (HIPAA: Health Information Portability & Accountability Act of 1996; http://www.hhs.gov ). The hospital will NOT speak with your accompanying advocate unless you have so designated them to perform in that role on your behalf. This empowerment of your Patient Advocate during this ER visit is not to be confused with the empowerment so designated in any previous Advance Directives that you may have previously signed. While the average health care consumer does not carry their Advance Directives around with them for an unexpected visit to the ER, it is extremely critical for a significant other in your life to have access to a legitimate copy of all directives so that your wishes can be carried out in the event that you become incapable of directing your own care.

Advocate Role:

As a patient you absorb a lot less information when it is noisy and chaotic, when you are anxious, vulnerable, in pain, afraid and undressed. Plan on keeping your Patient Advocate with you at all times, even overnight if you are going to need hospitalization. You will be able to rest much better. Your advocate can ask the questions that you may not think about when you are stressed. S/he will make sure you receive the correct medications and treatment. Your advocate can also help remember answers to questions you have already asked. S/he can speak up for you when you cannot use your own voice. Make sure your advocate knows the kind of care you want. Make sure s/he knows what you want done about life support and other life-saving efforts in the event that you are unconscious and not likely to get better. Go over the consents for treatment with your advocate. Make sure you both understand exactly what you agreeing to. Make sure sure your advocate knows the type of care you will need when you get home. Your advocate should know what to look for if your condition should worsen. S/he should also know who to call for help.

Identifying and Communicating With Your Health Care Team:

Expect health care workers to introduce themselves to you. Look for their identification (ID) badges which they are required to wear them at all times. Ask each person who enters your room their name, their title and what role they play in your overall care. If you are in the ER of a teaching hospital, it is possible that a medical student or intern will take your history. There is no need to be concerned because the information they collect will be shared with a senior doctor who will be the ultimate decision-maker with regards to your care. Be emotionally prepared to discuss your signs and symptoms numerous times with numerous personnel. You may not be able to use your cell phone in the ER and there may be no land line telephone to use in the area where you will be examined. Your advocate can walk out of the ER to make calls for you as needed. If English is not your first language, ask the nurse for an interpreter or other help with interpretation. AT&T provides a 24/7 hotline language service for interpretation to be used in the health care arena. Each doctor’s office or health care setting should have a code by which they can access this hotline. This phone number is 1-800- 752-6096. While it is not the ideal process, as they can’t be at the bedside with you whenever you need them, they can provide for some interactive exchange of information needed by your health care team.

Be Assertive, Yet Calm:

Your health is very important. It’s your body and you have a right to know everything about what’s going on. Be assertive and speak up. You have a voice…use it! Do not worry about being embarrassed if you don’t understand something that your doctor, nurse or other health care professional tells you. Ask questions and make sure they are answered in language you can understand. If you don’t understand because you speak another language, you have the right to get free help from someone who speaks your language. Write down your questions as they arise so that when the doctor makes his quick visit, you have them prepared to ask.

Your Rights as a Patient:

Each health care facility has in the past subscribed to a written Patient Bill of Rights that was created by the American Hospital Association in 1995. That document was replaced a few years ago by The Patient Care Partnership which uses plain language to inform patients about what they should expect during their hospital stay with regard to their rights and responsibilities. Expect to have your needs met and to be treated with kindness and dignity. If that does not happen, ask for the ER Supervisor. Hospital employed Patient Advocates will be more than happy to document any issues that might arise, but they have limited power to make anything happen, especially when it involves doctor-patient issues. When all else fails, call for the hospital chaplain. Regardless of your religious affiliation, s/he will be compassionate, caring and willing and able to get things done to help you.

Protecting Yourself From Hospital-Acquired Infections:

Each year hundreds of thousands of patients get infected with Hospital-Acquired Infections (HAIs) also known as Health-Acquired or Nosocomial Infections. Health care workers get trained on a regular basis regarding the critical importance of hand washing as the Number 1 way to prevent the spread of infection from patient to patient in the health care setting. If you do not see them wash or sanitize their hands before they administer care to you, it is in your best interest to remind them to do so. In order to further minimize your risk for an HAI, you or your advocate should use disinfectant wipes to disinfect the telephone, call bell, bedside table, and bed side rails. Ask your nurse for such wipes or other disinfectant for such purpose. Remind your own Patient Advocate about the importance of frequent hand washing, especially if s/he is going to be handling you or your belongings. It is also perfectly acceptable to ask each person using any equipment/machinery that will come in contact with your body to clean it first. Examples of such equipment/machinery would be a stethoscope, EKG machine, bandage scissors, etc. If the staff gets upset with any of these requests, let them know that you are merely trying to avoid getting a hospital-acquired infection. When all else fails, ask to speak with the ER Supervisor.

Diagnostic Tests in the ER:

The goal of the ER staff is to rule out any life-threatening condition or illness that you may be experiencing at the time. Not every patient seen in the ER will be admitted to the hospital. Sometimes you will be kept overnight in an observation area, but you are not actually admitted to the hospital. In most hospitals, this observation area is adjacent to the ER. If the doctor prescribes any tests for you, feel free to ask what is involved in the test, the purpose of the test, potential side effects, what they expect to learn, how long the test lasts, how long it will take to get the results, how much it costs, and who will be responsible for providing you with the results. Be sure your doctor gives you a written copy of the test results for your file. Be sure your doctor reads the written results of the test. You should also ask if there is the possibile need for any other tests. Sometimes the doctor wants to get the results of one test before scheduling another. This can be very time consuming. When possible, it is better if all tests are ordered at the same time in order to expedite the process and not have such long down time between the different tests. It is easier to cancel a scheduled test that has been deemed unnecessary than to first have to schedule it. This will provide the doctor with all of the results in a short period of time, thus minimizing the time spent in making the diagnosis and the length of your hospitalization. Be aware that the technicians who carry out the prescribed diagnostic tests are NOT allowed to discuss the findings with you. That is the doctor’s responsibility.

Your Safety & Security in the ER:

Each hospital has its own Security Department and well-trained Security Guards. There are many such guards stationed in the ER. They are there for the safety of the staff and patients. Don’t be afraid to ask about safety. If you’re going to need surgery, ask the doctor to mark the area that is to be operated on so there are no mistakes in the operating room. Don’t be afraid to tell the nurse or doctor if you think s/he has confused you with another patient. Tell your nurse or doctor if something just doesn’t seem right. Make sure every member of your health care team checks your hospital ID wristband and asks for your name before he or she gives you any medication or treatment. Don’t be afraid to tell the nurse or doctor if you think you are about to get the wrong medication. When you go to another department for a diagnostic procedure, be sure the technician knows who you are. Remain calm and ask your questions. It is always appropriate to get your questions answered…especially when it involves your safety and security. It is extremely important that you remain calm, polite and assertive while pleading the cause and advocating for yourself or someone else. When discussions with the doctor do not bring about the outcome you expect or desire, ask to speak with a nursing supervisor, the director of the ER, and in many cases, the hospital chaplin, who will take an active role in advocating for you, regardless of your faith.

Share Your Experience:

If you have a great experience as a patient or patient advocate, put it in writing through the vehicle that the health care setting provides. If the experience was negative, share that also. This is the most effective way to let hospital administrators know how their staff is doing. Employees can be rewarded or recognized for meeting the mission and goals of the facility through the provision of excellent care. And those employees who are not providing excellence can be aggressively mentored… or released from their positions.

Anecdotes:

One time I had my son, Richard, in the ER. The ER doctor came in to examine him. When he was done, I asked him ” Can you tell me why his toes are purple and his lips are more purple than usual? ” The doctor responded … “Are you sure? ” I said ” Yes, I’m sure “. He immediately moved my son to a room where he could be monitored. It turned out my son had a virus that attacked his heart.

It’s my child- I am the Voice. No one knows or loves their child better than a mother. The doctor moved quickly as I advocated for my son. If your instinct tells you that something is not right, keep advocating for the patient until someone satisfactorily addresses your concerns.

We brought our son, Jon, to the ER with complaints of severe abdominal pain. The ER doctor gave him the narcotic pain-reliever morphine and he felt better. No diagnosis had been made but the ER doctor told me that since Jon had no more pain, we could take him home. I was not comfortable with that because it had only been 2 hrs since the morphine had been administered and I was concerned that when the medication wore off, Jon might be in severe pain again. The doctor was insistent that he go home and I was insistent that we didn’t have enough info to take him home yet. When I questioned his decision to send my son home, the doctor got annoyed and walked out of the room. I sent my husband after him and while he was gone I took my memo pad and starting jotting down questions to ask the doctor upon his return. When he came back in with my husband, I remained very calm and just starting asking my questions. ” How can you send him home without a diagnosis? How do you know that the pain is permanently gone? How do you know that my son is not in trouble? ” I ignored the fact that the doctor was upset with my assertiveness because at this point this was all about my son’s safety and security and not about me or the doctor. I was adamant about not taking my son home until my questions were answered to my complete satisfaction. The doctor said that since I was so against my son being discharged, he was going to call in the hospitalist physician. By the time the hospitalist got there, my son was in severe pain once again. The hospitalist determined that my son should be admitted.

It’s my child- I am the Voice. No one knows or loves their child better than a mother. I was adamant about not taking my son home until my questions were answered to my complete satisfaction. At this point this was all about my son’s safety and security and not about me or the doctor. If your instinct tells you that something is not right, keep advocating for the patient until someone satisfactorily addresses your concerns. Bring a note pad with you either when you are the patient or the patient advocate. Write down all of your questions so you will be sure to get them all answered.

My 31 year old physician brother-in-law, Marty, was admitted to the ER with severe lower right-sided abdominal and lower right back pain, clinically indicating that he might be suffering from a kidney stone (renal calculi). Marty was admitted to the hospital for a diagnostic work up. An Intravenous (IV) infusion with antibiotics was started and a diagnostic Intravenous Pyelogram (IVP) test was ordered to see if he had any kidney stones. When the admitting physician spoke with the radiologist about the results of the IVP, the radiologist’s preliminary verbal report indicated that there were no stones. Marty felt better after 2 days and was discharged. What the admitting doctor failed to be aware of was that while the radiologist’s preliminary verbal report indicated no kidney stones, the official written report did show a suspicious looking mass in the colon which was pressing on the ureters (tubes that transport urine from kidney to bladder), giving clinical reason for Marty’s original pains. Marty had already been discharged by the time the written report was transmitted, and catastrophically for Marty, the report was placed in his chart in Medical Records without the attending doctor ever reading it. Marty walked around for 18 months undiagnosed and untreated before dying from cancer of the colon within 5 weeks of his Stage IV Colon Cancer diagnosis at the age of 33.

Make sure your doctor shares the written findings of all diagnostic tests with you. Request a copy of the results for your records.

I took my son to the hospital Emergency Room (ER). He has a complex medical history and this was one of many hospitalizations. While we were in the Admitting area, a Certified Nursing Assistant (CNA) came to perform a routine platelet count by way of a finger stick blood test. When I asked her why she was doing it and who ordered it, she told me that it is hospital policy to do this test routinely on all new ER admissions. ” This is what we do .” I explained to her that I wasn’t comfortable with that explanation. She was insistent on doing it. I was more insistent on her not doing it. She walked off angrily, slamming the door behind her. When I discussed this with the ER nurse, she told me that I had done the right thing. The admitting doctor was certainly going to order a complete round of laboratory blood tests to be drawn from his vein, and so there was no need to subject him to an unnecessary finger stick. You have a voice… use it to protect your child!

It’s my child- I am the Voice. I was adamant about doing the right thing for my child. I was not going to allow that finger stick until I knew what doctor ordered it and why. This was all about my son’s safety and security. If your instinct tells you that something is not right, keep advocating for the patient until someone satisfactorily addresses your concerns.

Terminology:

Advocate: One who pleads the cause of another; one who supports, defends, and verbally recommends a cause, proposal or line of action; advisor or supporter

Hospitalist: A doctor who works full time at the hospital; does not have own private practice.

Hospital-Acquired Infection (HAI); Health-Acquired Infection;(HAI) Nosocomial Infection: Infection that the patient acquires while in the health care setting; the patient did not have it when they arrived. Best prevention is by hand washing.

Intravenous Pyelogram (IVP): Diagnostic test in which a dye is injected into you through an IV and the radiologist watches as the dye goes through your kidneys and ureters in the attempt to diagnose kidney stones or other kidney abnormalities.

Radiologist: Physician who specializes in performing/interpreting radiological tests, X-Rays, IVP’s, C-T Scans, MRI’s, Ultra Sounds, etc.

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